Provider Demographics
NPI:1235310558
Name:GAIDRY, JAMES WILFRED (MSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WILFRED
Last Name:GAIDRY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 EASTLAKE ST SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-4559
Mailing Address - Country:US
Mailing Address - Phone:321-984-0306
Mailing Address - Fax:321-984-0306
Practice Address - Street 1:900 EASTLAKE ST SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-4559
Practice Address - Country:US
Practice Address - Phone:321-984-0306
Practice Address - Fax:321-984-0306
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW1798174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist